Wow. That Is A LOT of Dough............
I am a FF/PM in a Fire/Rescue/EMS dept. A "BLS" transport in our service is about $250 +$6/mile. An ALS transport is $450 +$6/mile. If we come to your house and treat you, and you then refuse transport to the hospital, we charge nothing.
Most insurance will cover a transport for a "true" emergency (which THEY determine, not YOU) to the CLOSEST appropriate facility (once again, determined by THEM, not YOU). If you want to go to a hospital farther away than one closer, insurance isn't going to pick up the difference.
When you call the ambulance so you get wheeled in the back of the ER as opposed to waiting up front, it's going to cost you a LOT more. As it should.
And our dept writes off about 1/3 of it's billings every year. That's 1/3 of 10,000 transports a year. By people who's insurance didn't cover the ride for a cold and simply refuse to or cannot afford to pay.
And medicare/medicaid will not pay unless someone is just about dead. Their standard operating procedure is to refuse EVERYTHING and to make the billing agency jump through hoops like a trained poodle to get any reimbursement at all.